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Tuesday, December 17, 2013

MiM Mail: Babies and money

Dear MiM,

I have been following this blog since before starting medical school. It's been so great to be able to draw from your experiences, and to know that it is possible to make family and medicine work (even if it's a little rough). I am a second year medical student getting married in June. My fiancé is a wonderfully kind, caring person who is more than supportive of my career goals in every way. I'm trying to figure out the whole first kid during training thing and I'm wondering if any of you have advice on how to make it work financially.

My fiancé (F) and I have been under a lot of financial pressure since I went back to medical school, largely due to the loss of my income and the fact that I am currently in repayment for several private loans from undergrad (I could be the poster child for the student loan bubble, and no, they won't let me defer… even though I'm in school). The thought of having a kid in medical school didn't even occur to me because we can barely afford our dog's vet bills, much less a baby. Well, lucky us, F got a pretty significant raise, and now we are looking at having a pretty livable income, and the first thing that popped into my head was, "Awesome! Now we can try to have a baby during M4!"

My concern is this: We are only just getting to the point where we don't hit 0 in the account every month. F works in fashion production/photography, so while I know he will most likely be able to work from home some of the time, there are days and weeks where his schedule looks worse than an intern's and is probably more unpredictable. This, of course, means we'll need to work out child care. Unfortunately we live in Westchester, just outside NYC, so everything is more expensive: rent, car insurance, food, and (I'm assuming) daycare. We do have family support (his entire family lives near by, including his sister who is a stay at home mom and great with kids) which is great for emergencies, but I feel like we would need to have something in place for the regular day to day.

For those of you that had kids in med-school/residency, how did you budget? I know if I wait until residency, childcare will be a lot easier to pay for because we'll have a second income, but I also like the idea of having a little more time with my first born, and being pregnant during what will probably be a comparatively docile year (especially since I'm thinking I want to do OB GYN). While all of that sounds great, I don't want to get myself into a situation where I'm not able to do what's best for my child because I didn't adequately plan ahead.

11 comments:

You should look into the cost of daycares in your area, and in the cities you're considering for residency. Also inquire about wait list time. We currently pay $400/week in a cheaper east coast city. Because of our schedules, and because we have no family in the area, we also require someone to do daycare dropoffs and pickups. Nannies cost $10-15/hr in our area, plus taxes (add another 20% -- it's illegal not to pay them).

Other alternatives include au pairs, nanny shares, and in-home daycares.

Someone may tell you that it costs "nothing" to have a baby, and make a comment about how out of line your priorities are for spending so much on childcare. These people have relatives or stay at home spouses who provide "free" labor to them. If you do not have that (we do not), you will pay out the nose.

We pay 435/wk in daycare in an expensive east coast city. We have family to help with pick ups every day otherwise as omdg notes, we would also need a part time nanny. Part time reliable child care is 20/hr here (+tax). We are able to budget Bc my husband has a good job (I'm an ms3) and we have a lot of family support. The downside is that this significantly restricts us geographically in the match next year.

I did residency at MFCH at WMC (NYMC) and gave birth 3 months into intern year with no family around to help. We got family to fly out and help take care of the baby from week 5 through 8 (since I didn't get real maternity leave), then my dear son was at Ann and Andys daycare in Elmsford from 2 months old until I finished residency (almost 3 years). We loved them, they are open 7am to 5:45pm Mon through Fri, and are reasonably priced, plus we met the best babysitters through them, which we used on the off days. BUT my husband still had to take plenty of time off and we were both chronically sleep deprived. There's never a good time to have a baby, and it will always be financially restrictive, but M4 is better than any other time, and there are certainly many options in Westchester, NY (not just the ones we chose).

PS you WILL be on a budget, we never went out, and every cent we had went to daycare/babysitters/food/rent. We do not have cable TV (still), but prioritizing having kids was way worth it and my only regret is not having kids earlier. Also, we found the most amazing babysitter, but I think it was something like $20/hr :(

We have a in-home nanny who does light cleaning for us as well (during naptime, etc.) I know it may seem lavish/unnecessary, but that light cleaning aspect has literally made our home livable and our marriage much calmer. I'm an MS2, my husband works full time, and our daughter was born 3 months before I started med school. The in-home nanny cut out a commute, and let both of us leave if she was still sleeping, sick, etc. It gets expensive, though- we hardly ever go out, eat simply, and have a lot of family support with baby stuff, emergency babysitting, etc. Also, keep in mind that babies don't always come when planned. It surprised me, and most of my friends who are having kids, how long it may take to actually get pregnant. Good luck and hope it all works out!

Thank you guys so much for your responses! This has been very helpful! It sounds like childcare is doable but with some pretty tight budgeting and family assists if available (especially if you are in/outside a major metro area).

Does anyone have any thoughts/experiences about childcare needs and ability to be home with baby in 4th year? I'm sure a lot depends on your program/rotations/how much time you use for interviews etc. Did anyone have particularly good/bad experiences with your medical school? Is it useful to talk to your deans to see what options are available before making a go at baby?

Cigal MD, how did you like WCMC for residency? Did you feel like this was a good area to try to do residency/kids? I've met few residents (mostly OB/GYN and surgery) and they seem to love the program, but none of the people I know in the program have children.

I live in NYC as well. I did an OB residency here and I am now doing a fellowship. You should definitely look at the nanny option. My husband and I found that the nanny was only slightly more expensive than a good daycare with extended hours and it gives us significantly more flexibility. For example...when I am on service and my husband is traveling for business my nanny works 630a-630p. When I am on research she works 9a-3p and sometimes less. It took me months to be comfortable leaving my baby with my nanny...I cried multiple mornings during the commute, but it gets easier. My nanny will never replace me, but my baby loves her and she is wonderful with him.

Additionally...OB is a tough field, but you can make it work with a family. I had a baby early during the clinical year of my fellowship. The hours were rough at times but I found in some ways that it was easier being around a bunch of OB's when I came back to work. I went back to work when he was 8 weeks old and managed to exclusively breastfeed for a year...pumping wasn't foreign or odd to my collegues.

I had mine in medical school (between 1st/2nd year) and in retrospect it was a lot easier during med school. Now that I'm a resident and a) know how busy my schedule is and b) know how much additional sleep deprivation and work and cost goes into having a baby, we're not feeling ready to have a 2nd child.

One thing to consider if your fiance/spouse does not make much money is that you may be eligible for some support while you're in medical school with zero income. I didn't realize until my little one was already almost a year old that my family was eligible for WIC, food stamps, medicaid (free health insurance, no co-pays on prescriptions) for our baby and low-income daycare as my husband did not make much money. Now that I'm a resident our family's income is about $1000 annually more than the cut-off for these financial support systems which means we feel even more stretched financially. Residents do not make that much money. A huge swath of my monthly paycheck goes towards health insurance for my family. There are lots of other new costs that came with residency too (steep parking contracts, step 3, licensing fees, extra babysitting hours for extra long hours (if you work a 16-hour shift on a weekend day when daycare's closed and your spouse is out of town for business, there goes >$200 in babysitting fees!)).

I will always be grateful for the extra support we got during medical school. I wish I had known about those safety nets sooner because the first year was very hard financially. I will definitely pay it forward when I'm through all my training and have real salary.

Also, I just read your additional questions above. Don't have a pre-conception meeting with your dean. It's none of their business and they have to help you work it out. And there's no *right* time to have a baby--you and your partner just have to decide when you want to do it and do it. Don't seek permission/approval from a dean/residency program director ahead of time. Just my two cents. It may be good to talk to other women in your med school/residency programs to get THEIR advice prior to conception.

Mothers in Medicine is a group blog by physician-mothers, writing about the unique challenges and joys of tending to two distinct patient populations, both of whom can be quite demanding. We are on call every. single. day.

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